Hiatal hernia treatment

ABSTRACT

An improved hiatal hernia treatment enhances recovery after surgery by reducing a patient&#39;s pain at an area of treatment. The area of treatment contains a hiatal hernia and must be extensively divided before the hiatal hernia can be treated. The improved hiatal hernia treatment reduces pain through directed application of anesthetic via an applicator positioned within the area of treatment. Reduction of pain increases patient comfort reduces the need for pain medication, and lowers patient blood pressure to enhance recovery.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.15/963,491, filed Apr. 26, 2018.

BACKGROUND OF THE INVENTION Field of the Invention

The invention relates to hernia procedures and in particular to animproved hiatal hernia treatment.

Related Art

Hiatal hernias can cause acid reflux, difficulty swallowing,regurgitation, and pain. In addition, vomiting and gastrointestinalbleeding can occur. Though small hiatal hernias may have some symptoms,large hiatal hernias can be serious and require surgery. For example, ahiatal hernia having limited blood flow may need to be treated throughsurgery.

From the discussion that follows, it will become apparent that thepresent invention addresses the deficiencies associated with the priorart while providing numerous additional advantages and benefits notcontemplated or possible with prior art constructions.

SUMMARY OF THE INVENTION

An improved hiatal hernia treatment is disclosed herein. As will bedescribed further below, the improved hiatal hernia treatment enhancesrecovery after surgery by directly addressing pain caused by a hiatalhernia treatment. The reduction in pain reduces the need for painmedication, increases patient comfort, and health during thepostoperative recovery period.

In one exemplary embodiment, a method for an improved hiatal herniatreatment comprises exposing an area of repair containing a hiatalhernia with one or more surgical instruments, positioning one or moreapplicators at a hiatus, applying a first amount of anesthetic at anexterior surface of the hiatus with the one or more applicators, andapplying a second amount of anesthetic at an interior surface of thehiatus with the one or more applicators.

A valve of the applicators may be adjusted during the method. Inaddition, application of the first amount of anesthetic and the secondamount of anesthetic may be gravity driven. The area of repair may beexposed by dissecting connective tissue within the area of repair.

It is noted that the anesthetic may be applied to a portion of adiaphragm within the area of repair. In addition, the anesthetic may beapplied to a portion of an esophagus within the area of repair. Thehiatal hernia may be treated by reinforcing the hiatus.

In another exemplary embodiment a method for an improved hiatal herniatreatment comprises exposing an area of repair containing a hiatalhernia, positioning one or more applicators at a hiatus within the areaof repair, and applying an anesthetic to the hiatus with the one or moreapplicators when the one or more applicators are outside the hiatus andwhen the one or more applicators are inserted in the hiatus.

A valve of the applicators may be adjusted during the method. Inaddition, application of the first amount of anesthetic and the secondamount of anesthetic may be gravity driven. Similar to above, theanesthetic may be applied to a portion of a diaphragm within the area ofrepair. In addition, the anesthetic may be applied to a portion of anesophagus within the area of repair. The hiatal hernia may be treated byreinforcing the hiatus.

In yet another exemplary embodiment, a method for an improved hiatalhernia treatment comprises exposing an area of repair containing ahiatal hernia, positioning one or more applicators at a hiatus withinthe area of repair, and applying an anesthetic at distinct portions ofthe hiatus with the applicator without pressurization.

A nozzle of the applicator may be adjacent the hiatus when theanesthetic is applied. In addition, a nozzle of the one or moreapplicators may be inserted in the hiatus when the anesthetic isapplied. Similar to above, the anesthetic may be applied to a portion ofa diaphragm, an esophagus, or both within the area of repair.

Other systems, methods, features and advantages of the invention will beor will become apparent to one with skill in the art upon examination ofthe following figures and detailed description. It is intended that allsuch additional systems, methods, features and advantages be includedwithin this description, be within the scope of the invention, and beprotected by the accompanying claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The components in the figures are not necessarily to scale, emphasisinstead being placed upon illustrating the principles of the invention.In the figures, like reference numerals designate corresponding partsthroughout the different views.

FIG. 1 is an anterior view of an exemplary abdominal region of a patientin a normal condition;

FIG. 2 is an anterior view of an exemplary abdominal region of a patientin an early stage condition;

FIG. 3 is an anterior view of an exemplary abdominal region of a patientin a herniated condition; and

FIG. 4 is an anterior perspective view of an exemplary abdominal regionof a patient and area of repair;

FIG. 5 is an anterior perspective view of an exemplary area of repairwith a treated hiatal hernia;

FIG. 6 is an anterior perspective view of an exemplary area of repairundergoing application of anesthesia;

FIG. 7 is an anterior perspective view of an exemplary area of repairundergoing application of anesthesia;

FIG. 8 is a flow diagram illustrating an exemplary improved hiatalhernia treatment; and

FIG. 9 illustrates an exemplary applicator.

DETAILED DESCRIPTION OF THE INVENTION

In the following description, numerous specific details are set forth inorder to provide a more thorough description of the present invention.It will be apparent, however, to one skilled in the art, that thepresent invention may be practiced without these specific details. Inother instances, well-known features have not been described in detailso as not to obscure the invention.

The improved hiatal hernia treatment herein is advantageous for patientrecovery. A significant amount of tissue dissection occurs during ahiatal hernia repair treatment. This is because such tissue must bedissected in order to access the area of repair. The improved hiatalhernia treatment anesthetizes the area of repair to reduce pain andenhance recover after the treatment is completed.

FIG. 1 illustrates an anterior view of an exemplary abdominal area in anormal condition. The esophagus 112 is shown extending through thediaphragm 108 to the stomach 104 via the hiatus 120. The stomach 104comprises a fundus 116, a lesser curve 124, and a greater curve 128. Ascan be seen, the greater curve 128 at the fundus 116 forms a generallyacute angle where the greater curve meets the esophagus 112 in a normalcondition. In addition, the esophagus 112 extends through the diaphragm108 via the hiatus 120 to the stomach 104 below in a normal condition.

In an early stage condition, the greater curve 128 at the fundus 116forms a generally obtuse angle where the greater curve 128 meets theesophagus 112. The same is illustrated in the exemplary anterior view ofthe abdominal area shown in FIG. 2. In an early stage condition, thestomach 104 slides upward toward the diaphragm 108 but remains below thediaphragm.

In a herniated condition, a portion of the stomach 104, such as thefundus 116, may slide through the hiatus 120 an into the chest. This maybe caused by a tear or weakness of the hiatus 120 of the diaphragm 108.A patient may experience chest pain, heartburn or both. In seriouscases, blood flow to the stomach 104 may be strangled or limited.

In such cases, surgery may be recommended to repair or reduce thehernia. In addition, in early stage conditions, surgery may be utilizedto decrease or reinforce the hiatus 120 to prevent a hiatal hernia fromforming or enlarging.

One cause of hiatal hernias is obesity. As such, patients undergoinggastric surgery may also undergo an improved hiatal hernia treatmentwhere by the hiatus 120 is reinforced or otherwise repaired, a hiatalhernia is reduced or repaired, or both as appropriate when an earlystage condition or herniated condition is detected.

Referring to FIG. 4, which illustrates an anterior view of an exemplaryabdominal region as may be seen from a laparoscope, the stomach 104 maybe surrounded and connected to other portions of the abdominal regionvia connective tissue 412. Connective tissue may comprise fat, bloodvessels and other structures.

The area of repair 404 shown is below the lungs 408 and adjacent thefundus 116 of the stomach 112. In one or more embodiments, the area ofrepair 404 will be that containing the hiatus where it meets theesophagus. The connective tissue 412 surrounding the area of repair 404must be dissected, divided, or both to expose the hiatus and esophagus.Dissection may be accomplished with various laparoscopic instruments.Typically, this area of a patient contains significant amounts ofconnective tissue 412 which must be dissected or divided before a hiatalhernia can be repaired. This causes trauma to the area.

It is noted that the area of repair 404 may differ, such as by beinglarger or smaller, for different patients. In addition, more extensivedissection may occur to access the area of repair 404 in some cases. Forexample, dissection may occur further into the chest cavity, superior tothe diaphragm or area of repair 404. As will be discussed below, suchdissection may be treated as part of the improved hiatal herniatreatment disclosed herein to aid in patient recovery.

An exemplary area of repair after dissection is shown in FIG. 5. Theconnective tissue 412 has been dissected or divided sufficient to revealthe diaphragm 108, hiatus 120, and esophagus 112. As can be seen, a tear504 is adjacent the hiatus 120 which would allow the stomach to enter orpass through the hiatus, creating a hernia. However, as shown, theesophagus 112 and stomach have been positioned, such as shown in thenormal condition of FIG. 1, and the hiatus 120 has been reinforced bytying surgical suture 508 to prevent the stomach from sliding orotherwise moving into or through the hiatus.

Though illustrated as a posterior repair procedure in FIG. 5, it isnoted that various repair procedures may be utilized. For example,repair may occur from an anterior position in some embodiments.

FIGS. 6 and 7 illustrate application of anesthesia at the area of repairvia an applicator 604. As can be seen, anesthetic 612 may be applied tovarious surfaces in an area of repair by an applicator 604. In FIGS. 6and 7 for example, the applicator 604 allows a fluidic flow ofanesthetic 612 to flow onto and coat internal and external surfaces ofthe hiatus 120 and diaphragm 108. In FIG. 6, the applicator 604 appliesanesthetic 612 to an external surface of the diaphragm 108 and hiatus120 where the surgical suture 508 has been added.

An open end, outlet, or nozzle 608 of the applicator 604 may be used tocontrol the locations at which anesthetic 612 is applied. For example,FIG. 7 illustrates that the applicator 604 may apply anesthetic to aninterior surface of the hiatus 120, such as by insertion of theapplicator's nozzle 608 into the hiatus 120 or tear 504. In addition, anapplicator 604 may increase or decrease the flow rate of anesthetic 612as desired such as by constricting or expanding a valve or the likethereof.

As alluded to in the foregoing, an applicator 604 may comprise a tubularstructure in fluid communication with a reservoir or source holding aquantity of anesthetic 612. In use, the anesthetic 612 may flow from thereservoir and through the applicator 604 where it may be applied to asurface via the nozzle 608 of the applicator. It is noted that,typically, an applicator 604 will not inject or otherwise pressurize theanesthetic 612 but rather the anesthetic will be driven by gravity outof the applicator's nozzle 608 and onto the desired surface or surfaces.

Application of anesthetic 612 reduces pain at the area of repair for anumber of hours after the improved hiatal hernia treatment is completed.In some cases, pain can be reduced for approximately six hours after theimproved hiatal hernia treatment is completed. The period of timeimmediately after a surgical procedure is typically the most painful forpatients. Reduction of pain is beneficial in lowering patient stress,discomfort, and heartrate, especially during the postoperative period.In addition, the need for postoperative pain medication, and during theperioperative period overall, is typically reduced as compared totraditional procedures.

The improved hiatal hernia treatment will now be described with respectto the exemplary flow diagram of FIG. 8. At a step 804, the connectivetissue surrounding an area of repair may be divided or otherwisedissected with one or more laparoscopic or other surgical instruments.For instance, as described above, fatty tissue and blood vesselsconnected to the esophagus, stomach, and diaphragm may be dissected toexpose the area of repair.

At a step 808, a treatment may be executed. In one or more embodiments,the treatment reinforces the hiatus to prevent a hernia from forming orenlarging. A treatment may include repositioning a herniated stomach. Asurgical suture, staples, or other reinforcement devices may be sewn,tied, or otherwise implanted to reinforce or repair the hiatus.

After treatment is completed, an applicator may be positioned adjacent asurface at a step 812, such as a surface of the hiatus, diaphragm, orother adjacent structure. The applicator will typically be positionedsuch that its nozzle is adjacent the surface. At a step 816 anestheticmay be applied to the selected surface, such as by permitting theanesthetic to flow out of the applicator's nozzle. This coats thesurface with anesthetic thereby numbing the surface to pain.

At a decision step 820, additional surfaces may have anesthetic appliedthereto such as by returning to step 812 to position the applicatoradjacent another surface. As illustrated in FIGS. 6 and 7 for instance,anesthetic is applied an interior surface of the hiatus as well as anexterior surface of the hiatus. Anesthetic may be applied to one or moredissected areas as well, including any dissections superior to orotherwise adjacent to an area of repair. As can be seen, this processmay be repeated one or more times to apply anesthetic to other organsurfaces within or adjacent the area of repair.

Once all desired surfaces have had anesthetic applied thereto, thepatient may be closed for recovery at a step 824, such as by removingany instrumentation, pads, or other surgical implements and closingincisions with staples, sutures, or the like. The patient can thenproceed to the postoperative recovery stage. As can be seen, theapplication of anesthetic may be specific to the area of repair, wherethe patient is likely to experience the most pain after surgery. This isadvantageous in reducing the need for other pain medication as whileimproving patient comfort and heart rate, thereby enhancing the recoveryprocess.

Though described herein with regard to hiatal hernia treatments, it iscontemplated that anesthetic may be applied as described herein during avariety of surgeries to directly address pain at various areas ofrepair. Typically, anesthetic will be applied after a treatment butprior to completion of the treatment (i.e., the end of the surgicalprocedure). It is contemplated though that, in some embodiments,anesthetic may be applied to an area of repair during the postoperativeperiod, such as by introducing an applicator laparoscopically andapplying anesthetic to one or more surfaces, as disclosed herein.

In one or more embodiments, an applicator 604 will be a laparoscopicinstrument to permit use while minimizing the size of incisions in thepatient. An exemplary applicator 604 is shown in FIG. 9. As can be seen,an applicator may comprise an inlet 916 and a nozzle 608 or outlet. Atubular shaft or body 920 may extend between an inlet 916 and nozzle608. In one or more embodiments, the body 920 may be rigid and extendvarious lengths, as indicated in FIG. 9.

As disclosed above, in operation, the nozzle 608 of an applicator 604may be positioned adjacent a selected surface. Thereafter, anestheticmay flow through the applicator 604 and out the nozzle 608 forapplication to the surface. The flow rate may be controlled by a valve912 or the like of the applicator 604.

One or more reservoirs 908 may be provided to hold anesthetic. A conduit904 may connect the inlet 916 of an applicator 604 to the reservoir 908to allow the applicator to receive anesthetic therefrom. The conduit 904will typically be flexible to allow free movement of the applicator 604,such as to position the nozzle 608 adjacent a selected surface.

While various embodiments of the invention have been described, it willbe apparent to those of ordinary skill in the art that many moreembodiments and implementations are possible that are within the scopeof this invention. In addition, the various features, elements, andembodiments described herein may be claimed or combined in anycombination or arrangement.

What is claimed is:
 1. A method for an improved hiatal hernia treatmentcomprising: exposing an area of repair containing a hiatal hernia withone or more surgical instruments; positioning one or more applicators ata hiatus; applying a first amount of anesthetic at an exterior surfaceof the hiatus with the one or more applicators; and applying a secondamount of anesthetic at an interior surface of the hiatus with the oneor more applicators.
 2. The method of claim 1, further comprisingadjusting a valve of the one or more applicators.
 3. The method of claim1, wherein application of the first amount of anesthetic and the secondamount of anesthetic is gravity driven.
 4. The method of claim 1,wherein the area of repair is exposed by dissecting connective tissuewithin the area of repair.
 5. The method of claim 1, further comprisingapplying the anesthetic to a portion of a diaphragm within the area ofrepair.
 6. The method of claim 1, further comprising applying theanesthetic to a portion of an esophagus within the area of repair. 7.The method of claim 1, further comprising treating the hiatal hernia byreinforcing the hiatus.
 8. A method for an improved hiatal herniatreatment comprising: exposing an area of repair containing a hiatalhernia; positioning one or more applicators at a hiatus within the areaof repair; and applying an anesthetic to the hiatus with the one or moreapplicators when the one or more applicators are outside the hiatus andwhen the one or more applicators are inserted in the hiatus.
 9. Themethod of claim 7, further comprising adjusting a valve of the one ormore applicators.
 10. The method of claim 7, wherein application of theanesthetic is gravity driven.
 11. The method of claim 7, furthercomprising applying the anesthetic to a portion of a diaphragm withinthe area of repair.
 12. The method of claim 7, further comprisingapplying the anesthetic to a portion of an esophagus within the area ofrepair.
 13. The method of claim 7, further comprising treating thehiatal hernia by reinforcing the hiatus.
 14. A method for an improvedhiatal hernia treatment comprising: exposing an area of repaircontaining a hiatal hernia; positioning one or more applicators at ahiatus within the area of repair; and applying an anesthetic at distinctportions of the hiatus with the applicator without pressurization. 15.The method of claim 14, further comprising adjusting a valve of the oneor more applicators.
 16. The method of claim 14, wherein application ofthe anesthetic is gravity driven.
 17. The method of claim 14, wherein anozzle of the one or more applicators are adjacent the hiatus when theanesthetic is applied.
 18. The method of claim 14, wherein a nozzle ofthe one or more applicators are inserted in the hiatus when theanesthetic is applied.
 19. The method of claim 14, further comprisingapplying the anesthetic to a portion of a diaphragm within the area ofrepair.
 20. The method of claim 14, further comprising applying theanesthetic to a portion of an esophagus within the area of repair.